-
[show abstract]
[hide abstract]
ABSTRACT: Insomnia is a major public health concern affecting about 10% of the general population in its chronic form. Furthermore, epidemiological surveys demonstrate that poor sleep and sleep dissatisfaction are even more frequent problems (10-48%) in the community. This is the first report on the prevalence of insomnia in Greece, a southeastern European country which differs in several socio-cultural and climatic aspects from the rest of European Community members. Data obtained from a national household survey (n = 1005) were used to assess the relationship between insomnia symptoms and a variety of sociodemographic variables, life habits, and health-related factors.
A self-administered questionnaire with questions pertaining to general health and related issues was given to the participants. The Short Form-36 (Mental Health subscale), the Athens Insomnia Scale (AIS) as a measure of insomnia-related symptoms, and the International Physical Activity Questionnaire (IPAQ) were also used for the assessment.
The prevalence of insomnia in the total sample was 25.3% (n = 254); insomnia was more frequent in women than men (30.7% vs. 19.5%) and increased with age. Multiple regression analysis revealed a significant association of insomnia with low socio-economical status and educational level, physical inactivity, existence of a chronic physical or mental disease and increased number of hospitalizations in the previous year.
The present study confirms most findings reported from other developed countries around the world regarding the high prevalence of insomnia problems in the general population and their association with several sociodemographic and health-related predisposing factors. These results further indicate the need for more active interventions on the part of physicians who should suspect and specifically ask about such symptoms.
BMC Public Health 01/2010; 10:531. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to investigate the independent correlations of subjective sleep disturbances (insomnia and daytime sleepiness) with the severity of fatigue in patients with major depression.
Eighty-one currently depressed patients (70 females and 11 males), aged between 23 and 65 years, with a DSM-IV diagnosis of major depressive disorder were studied. Patients with physical diseases or other conditions associated with prominent fatigue were excluded. The 17-item Hamilton Depression Rating Scale (HDRS), the Athens Insomnia Scale (AIS), and the Epworth Sleepiness Scale (ESS) were used for the cross-sectional assessment of the severity of depression, insomnia, and sleepiness, respectively. Severity of fatigue was measured with the Fatigue Severity Scale (FSS). Pearson's and Spearman's coefficients were used in bivariate correlations between FSS score and the independent variables (age, gender, inpatient/outpatient status, HDRS score, AIS total score, AIS individual item scores, and ESS score). A stepwise multiple regression analysis was then performed, with FSS score as the dependent variable.
The severity of fatigue was significantly correlated with female sex, HDRS score, AIS total score, awakenings during the night (AIS item 2), compromised sleep quality (AIS item 5), and ESS score. Sleep quality (AIS item 5) and daytime sleepiness (ESS) were the only significant predictors of the severity of fatigue in the multiple regression analysis.
Both sleep quality and daytime sleepiness correlate independently with fatigue severity, as measured with the FSS, in patients with major depression. The FSS does not appear to be a 'pure' measure of fatigue in depressed patients, a finding with potential implications for the choice of appropriate fatigue measures in this population.
Journal of Psychosomatic Research 02/2009; 66(1):37-42. · 3.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Data obtained from a national household survey in Greece (n=1005) were used to assess the relationship between physical activity and insomnia in a group of subjects suffering from several major disabling physical illnesses. A self-administered questionnaire with questions pertaining to general health and related issues was given to the participants. The Short Form-36, the Athens Insomnia Scale (AIS), and the International Physical Activity Questionnaire (IPAQ) were included in the assessment. Half (49.5%) of the participants had moderate or vigorous physical activity and 33.4% had a chronic somatic disease. The prevalence of insomnia in the total sample was 25.3% (n=254); subjects having moderate or vigorous physical activity were 56% less likely to have insomnia in univariate analysis. Multiple analysis revealed a significant interaction of physical activity with heart failure or myocardial ischemia (OR=0.054, 95% CI: 0.003-0.95), indicating that subjects having moderate or vigorous physical activity and heart failure or myocardial ischemia had lower odds for having insomnia compared to individuals with heart problems and low physical activity levels. Consequently, cardiac patients suffering from insomnia seem to benefit from physical exercise. Since sleep disorders are quite frequent in cardiac patients and may result in both physical and psychological complications which deteriorate even further their quality of life and health, our results need replication in this particularly vulnerable population.
International journal of cardiology 01/2009; 143(2):209-11. · 7.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In clinical practice, a proportion of patients with psychotic or mood disorders are treated with electroconvulsive therapy (ECT) while receiving concomitantly antipsychotic and/or other psychotropic agents. Aripiprazole is a second-generation antipsychotic that seems to have a favorable side-effect profile. However, to the best of our knowledge, there are, as yet, no available reports on the safety of ECT-aripiprazole combination. We report the cases of 4 female inpatients--3 suffering from major depression and 1 from schizophrenia--who underwent ECT--1 of them twice--while receiving aripiprazole (10-15 mg/d), as part of their regimen. In all cases, the combination was well tolerated and only minimal side effects were reported.
The journal of ECT 06/2008; 24(3):236-8. · 1.19 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aim of the present study was to retrospectively assess the impact of a catastrophic earthquake in a sample of 121 survivors, 50 years after the event. Mean age +/- SD of the responders was 72.2 +/- 6.1 years. The majority of the victims (78%) acknowledged a strong overall impact of the earthquake on their lives, and almost all of them had intense recollection of the event at its anniversary. The most frequent symptom during the 6 months after the earthquake was persistent remembering or "reliving" of the event; women had considerably more often recurrent dreams of the earthquake and distress than did men. Women and young adults at the time of the earthquake appear to be the most vulnerable groups regarding the psychological effects of the event.
The Journal of nervous and mental disease 05/2008; 196(4):340-4. · 1.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the effect of obstructive sleep apnea syndrome on the cognitive performance of young and middle-aged patients. Patients were divided into two groups, one consisting of 30 patients less than 50 years of age and the other consisting of 28 patients 50 years and over. Normal subjects were similarly divided into two groups, composed of 17 younger and 24 older controls. Patients and controls were examined with all-night polysomnography and subsequently underwent cognitive testing via attention-alertness tests. Comparing young to middle-aged patients, there were statistically significant differences in cognitive performance, especially in attention tests. Younger patients' cognitive performance was similar to their age-matched controls, while middle-aged patients showed cognitive decline in comparison with their age-matched controls. Although we studied only two age groups using 50 years of age as a cut-off, we could demonstrate that cognitive deterioration of untreated sleep apnea patients is age dependent, and several factors may contribute to this effect including brain hypoxia, sleep fragmentation, or comorbidities. Aging patients with sleep apnea demonstrate cognitive decline, while younger patients with the same disease severity are (somehow) able to compensate for this effect.
Sleep And Breathing 04/2008; 12(1):17-24. · 1.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite the recent progress in the pharmacological treatment of obsessive-compulsive disorder (OCD)--especially with high doses of serotonin reuptake inhibitors, alone or in combination with low doses of antipsychotics--a non-negligible proportion of patients remains refractory to it. For these patients augmentation tactics with drugs from other chemical classes, including antiepileptic drugs, seems advisable. We report on the case of a female inpatient with OCD, whereby the adjunction of tiagabine, a selective GABA reuptake inhibitor at 15 mg/day, to a fluvoxamine (400 mg/day)-risperidone (1 mg/day) combination led to the patient's marked improvement as reflected in the reduction by almost 47% of her score on the Yale-Brown Obsessive Compulsive Scale. With respect to tiagabine's specifically anti-OCD mechanism of action, we note that enhanced inhibitory GABAergic neurotransmission slows down excitatory glutamatergic transmission in the cortico-striato-thalamic system, which presumably constitutes the core pathophysiological mechanism of OCD symptoms.
The World Journal of Biological Psychiatry 12/2007; 10(4 Pt 3):953-5. · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although amisulpride is considered to be a prolactin-raising atypical antipsychotic drug, a limited number of studies have documented the extent of its prolactin-elevating properties. In the present study the effect of amisulpride on plasma levels of prolactin and the reversibility of this untoward side effect were investigated.
17 patients with various diagnoses received amisulpride (50-800 mg/day) or a combination of amisulpride plus other medication as needed. Plasma prolactin was determined 26.7+/-9.4 days (range: 13-50 days) after initiation of treatment and in 3 cases after a much longer period, and 14-51 days following its withdrawal.
All patients on amisulpride had hyperprolactinemia (mean+/-S.D. prolactin levels: 62.5+/-33.0 ng/ml) with females exhibiting considerably higher prolactin levels than males. Following amisulpride discontinuation prolactin levels were significantly (p<000) reduced (mean+/-S.D. prolactin levels: 12.3+/-6.7 ng/ml). No significant correlation was detected between prolactin levels and either amisulpride dosage or duration of administration.
Amisulpride has a pronounced prolactin-elevating effect which appears to be independent of dosage and duration of administration. Hyperprolactinemia rapidly reverses following amisulpride discontinuation.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 02/2007; 31(1):92-6. · 3.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recent research data suggest that inflammation and/or depression are associated with the development and progression of cardiovascular disease (CVD). Considering that depression may arise as a response to irrational beliefs according to the Ellis model of psychological disturbances and therapy, we sought to evaluate whether irrational beliefs are associated with plasma inflammatory factors in cardiovascular disease-free people.
From May 2001 to December 2002 we randomly enrolled 453 men (23-69 years old) and 400 women (24-71 years old) stratified by age and gender. C-reactive protein, interleukin-6, serum amyloid-A, tumor necrosis factor-alpha and white blood cells were measured in all participants. Detailed dietary characteristics of these people were assessed through a validated food frequency questionnaire. Subjects completed also the irrational beliefs inventory (IBI), which is a brief self-report measure consistent with the Ellis model of psychological disturbance and therapy and the Zung's Depression questionnaire.
The IBI scores were similar in men and women (53+/-11 vs. 53+/-10, p = 0.83). IBI score was positively correlated with C-reactive protein (rho = 0.14, p = 0. 02), interleukin-6 (rho = 0.11, p = 0.02), tumor necrosis factor-alpha (rho = 0.21, p = 0.014) and white blood cell counts (rho = 0.14, p = 0.02). These associations were confirmed even after adjusting for age, sex, years of school, body mass index, physical activity status, depression level and food items consumed by the participants.
These findings indicate that irrational beliefs are associated with increased inflammation process, among apparently healthy individuals.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 01/2007; 30(8):1496-503. · 3.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Abstract
Background
Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky – especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM.
Methods
We report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting list for pancreatic islet cell transplantation, she developed a manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days.
Results
The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day.
Conclusion
Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels and thus were also relatively contra-indicated. Moreover, the imminent post-transpantation immunosupressant treatment with immuno-modulating medicines also contra-indicated both valproate and carbamazepine. Despite the severe methodological limitations of case reports in general, the present one suggests that OXC as monotherapy might be both safe and efficacious in the treatment of acute mania in patients with early-onset type-1 DM, whose already compromised physical condition constitutes an absolute or relative contra-indication for the administration of standard treatments, though there are no, as yet, randomized clinical trials attesting to its efficacy unambiguously.
Annals of General Psychiatry. 01/2007;
-
[show abstract]
[hide abstract]
ABSTRACT: The profile of coping mechanisms in a sample of 164 subjects (60 alcohol-dependent individuals, 47 depressed patients, 57 controls) was investigated. Data were collected over the period January-December 2004, at the Eginition Psychiatric Hospital of the Athens University Medical School in Athens, capital of Greece. The Albert Einstein College of Medicine Coping Styles Questionnaire (AECOM-CSQ; Plutchik & Conte, 1989), and the Hamilton Depression and Anxiety Rating Scales (Hamilton, 1959, 1960) were used for the assessment. Post hoc analysis of variance for comparisons between groups and logistic regressions using coping styles as predictor variables for group classification were used for data analysis. The main findings were that alcohol-dependent individuals could be distinguished from either depressed or control subjects on the ground of their coping mechanisms with stress, and that men and women use different patterns of psychological adaptation. More specifically, group classification in terms of specific coping styles could be predicted with an overall accuracy of more than 84%; in men, classification related to the coping mechanism of substitution, and in women to blame, reversal, and substitution. These findings may have implications for individually tailored psychotherapeutic interventions in alcohol-dependent individuals.
Social Behavior and Personality An International Journal 12/2006; 35(5):599-614. · 0.31 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to evaluate the short-term psychological impact on family members of intensive care unit (ICU) patients during their stay in the unit.
Thirty-two first-degree relatives of patients treated in the ICU of two general hospitals were investigated for symptoms of early posttraumatic stress reaction, anxiety, and depression. Patients' and relatives' sociodemographic data and information pertaining to the patients' ICU treatment were collected. Family members were assessed at intake and before discharge through the Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory, and the Impact of Event Scale.
High rates of anxiety, depressive (97%), and posttraumatic stress (81%) symptoms were recorded at the initial assessment. Although symptoms remitted significantly, 87% and 59% of the sample fulfilled the criteria for a depressive and posttraumatic stress reaction, respectively, at the second assessment. Women exhibited higher levels of distress and more persisting symptoms than men did. Trait anxiety was the most significant predictor (P<.001) of the severity of depressive symptoms and the single predictor of the development of posttraumatic stress reaction (P<.000); also, state anxiety was a predictor of the development of posttraumatic stress symptoms, especially of the female gender.
Family members of ICU patients exhibit high levels of distress that persist throughout their relatives' hospitalization. Women and individuals with high trait anxiety are at increased risk for developing such reactions. Severe early anxiety responses predicted the development of posttraumatic stress symptoms. Early case identification and intervention may prevent the full development of posttraumatic stress disorder.
Journal of Psychosomatic Research 11/2006; 61(5):719-22. · 3.30 Impact Factor
-
Journal of Clinical Psychopharmacology 05/2006; 26(2):208-9. · 4.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Anxiety is a complex feeling of uneasiness, fear and worry, which has been associated with pulmonary, cardiovascular and other adverse health conditions. The aim of this work is to examine the association of the anxious state with inflammation and coagulation factors, in persons free of cardiovascular disease.
From May 2001 to December 2002 we randomly enrolled 453 men (19 to 89 years old) and 400 women (18 to 84 years old) stratified by age and gender, from Attica area, Greece. Among others, various inflammation and coagulation markers (C-reactive protein (CRP), amyloid-A, interleukin-6, tumor necrosis factor-alpha, white blood cell (WBC), homocysteine and fibrinogen) were evaluated in relation to the anxious state (assessed by the Spielberger State Anxiety Inventory, STAI) of participants, after several adjustments made for potential confounders.
STAI score was positively correlated with C-reactive protein (rho = 0.18, p = 0.01), tumor necrosis factor-alpha (rho = 0.11, p = 0.03), interleukin-6 (rho = 0.09, p=0.03), homocysteine (rho = 0.10, p = 0.03) and fibrinogen levels (rho = 0.08, p = 0.04), in men, and positively correlated with C-reactive protein (rho = 0.22, p = 0.01), white blood cell counts (rho = 0.15, p = 0.02), interleukin-6 (rho = 0.12, p = 0.02), homocysteine (rho = 0.07, p = 0.04) and fibrinogen levels (rho = 0.07, p = 0.04), in women. These associations remained significant even after various adjustments were made.
This study revealed that anxiety was associated with inflammation and coagulation markers in cardiovascular disease-free people. This may raise a hypothesis of a pathway leading to increased cardiovascular events in anxious individuals.
Atherosclerosis 05/2006; 185(2):320-6. · 3.79 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Working memory deficiency has been implicated in developmental disorders of scholastic skills. The auditory P50 component of event-related potentials reflecting preattentive processing was investigated in 38 children with developmental disorders of scholastic skills and 19 sibling control children, as elicited during a working memory test. The P50 was evoked by two tones of low and high frequency (500 Hz and 3000 Hz). The group with developmental disorders of scholastic skills showed prolonged P50 latency induced by the low tone, located at the frontal area. The amplitude of P50 induced by the low tone exhibited significantly negative associations with both age and memory performance, whereas age and memory performance were associated positively. These findings indicate that preattentive processing deficits may be implicated not only in auditory cognition but also in developmental disorders of scholastic skills.
Neuroreport 12/2005; 16(16):1829-32. · 1.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Over the last years, a large body of evidence has accumulated showing that complaints of disordered sleep are quite prevalent in the community. Insomnia is by far the most common disturbance and is often associated with concurrent psychiatric illness, in particular anxiety and mood disorders. On the other hand, sleep complaints are frequently present among psychiatric patients and have been incorporated in the official diagnostic criteria for many mental disorders, such as major depression, post-traumatic stress disorder, generalized anxiety disorder and substance-related disorders. Estimates of the prevalence of sleep disorders diverge widely, because these disorders have been variously conceptualized. Currently, however, three different classifications for sleep disorders establish reliable diagnostic criteria and allow for more consistency in clinical research. In particular, the ICD-10 diagnostic criteria for insomnia helped to establish a consensus among sleep specialists by defining accurately this clinical condition, i.e. by conceptualizing it as the subjective complaint of insufficient or non-restorative sleep, which is the important feature, not the actual amount of time spent asleep. Alongside the evolution of taxonomic systems, the development of specific diagnostic tools, such as rating scales for measuring clinical manifestations of sleep disorders, has contributed significantly to the growth in the field. For instance, the risk factors responsible for the development of chronic insomnia, its consequences, and the complex relationship between insomnia and psychopathology, have been considerably clarified. In terms of the polysomnographic aberrations observed in various mental disorders, these, although proven not to be pathognomonic for any of them, have been considerably refined over the last decade, and certain general sleep patterns for some specific disorders have emerged. Finally, substantial advances have been made in the elucidation of the neuropsychobiological substrate of disturbed sleep. Thus, hyperarousal has been identified as the cardinal feature of chronic insomnia, which is associated with an around-the-clock activation of both major components of the stress system, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.
World psychiatry: official journal of the World Psychiatric Association (WPA) 11/2005; 4(3):186-90. · 6.23 Impact Factor
-
Epidemiologia e psichiatria sociale 16(4):356-62. · 3.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Auditory hallucinations occupy, along with delusional beliefs, the center stage of active or "positive" psychotic clinical psychopathology. During the last decade, several sets of auditory hallucinations' clinical features were subjected to multivariate statistical analyses to disclose major dimensions of psychotic patients' overall hallucinatory experience and behavior. However, these studies failed, to a large extent, to provide satisfactory external validations of the thereby extracted factors.
We investigated the major clinical dimensions of verbal auditory hallucinations in a sample of 100 inpatients with schizophrenic disorders. Patients (61 men and 39 women) were examined before the initiation of antipsychotic treatment and their assessment included 18 major clinical features of auditory hallucinations. Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, Global Assessment Scale, and Mini-Mental State Examination were used as external validators.
Principal component analysis resulted in the extraction of 5 factors interpreted as the dimensions of severity of auditory hallucinations, emotional and behavioral impact, rate of their intrusion in self-consciousness, delusional elaboration, and similarity to ordinary auditory perception, respectively. The second and third factors extracted in our study correlated with short duration of illness, whereas the first, fourth, and fifth ones correlated with chronicity. Our second factor correlated with clinical severity of patients' current mental state, the fifth factor with severity of their cognitive impairment, and the first and fourth ones with lower clinical depression despite patients' chronicity.
The findings of our study contribute to the further elucidation of the major clinical dimensions of auditory hallucinations and the testing of their external validity.
Comprehensive Psychiatry 48(4):337-42. · 2.26 Impact Factor
